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# Diclofenac Tablets
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis. It is available in various formulations, including immediate-release (IR) and delayed-release (DR) tablets.
## Primary Indications
* Pain management
* Inflammation associated with osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and acute musculoskeletal disorders.
* Primary dysmenorrhea.
## Adult Dosing
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:**
* IR tablets: 50 mg orally two to three times daily.
* DR tablets: 75 mg orally twice daily.
* Maximum recommended daily dose: 225 mg.
* **Acute Pain, Primary Dysmenorrhea:**
* IR tablets: Initial dose of 50 mg orally, followed by 50 mg every 8 hours as needed. Do not exceed 200 mg in the first 24 hours.
* DR tablets: Initial dose of 50 mg orally, followed by 50 mg every 8 hours as needed.
## Pediatric Dosing
Diclofenac is generally not recommended for use in pediatric patients for the indications listed above, except for specific formulations and indications not covered by this general request. Consult specific product labeling or pediatric formularies for established pediatric dosing where applicable.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Monitor liver function closely. Dose reduction may be necessary.
* **Renal Impairment:** Use with caution. Monitor renal function. NSAIDs can cause renal injury.
* **Elderly:** Increased risk of adverse effects. Use the lowest effective dose.
## Contraindications
* Hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Inflammatory bowel disease (active).
* Severe heart failure.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, abdominal pain, diarrhea, constipation, peptic ulceration, GI bleeding, perforation.
* **Cardiovascular:** Increased risk of myocardial infarction, stroke, hypertension, fluid retention, edema.
* **Renal:** Renal impairment, acute renal failure.
* **Hepatic:** Elevated liver enzymes, hepatitis, jaundice.
* **Dermatologic:** Rash, pruritus.
* **Other:** Headache, dizziness, tinnitus.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Aspirin:** Increased risk of GI toxicity; diclofenac may interfere with the cardioprotective effect of low-dose aspirin.
* **Corticosteroids:** Increased risk of GI toxicity.
* **Diuretics, ACE inhibitors, ARBs:** Increased risk of renal impairment and reduced antihypertensive efficacy.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
* **SSRIs/SNRIs:** Increased risk of bleeding.
## Monitoring
* **Baseline and periodic renal function tests** (serum creatinine, BUN).
* **Baseline and periodic liver function tests** (ALT, AST).
* **Blood pressure monitoring**, especially in patients with hypertension.
* **Signs and symptoms of GI bleeding.**
* **Signs and symptoms of cardiovascular events.**
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Consider a gastroprotective agent (e.g., proton pump inhibitor) in patients at high risk for GI complications.
* Patients with pre-existing cardiovascular disease or risk factors should use diclofenac with caution.
* Avoid concomitant use with other NSAIDs.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making therapeutic decisions.*
